Posts Tagged ‘literacy’

Illiteracy has its Rewards

Tuesday, October 19th, 2010

When a laborer is unable to perform physical work, the options are limited, not only for the worker, but for the workers comp system as well. Meet Pennsylvania’s Sam Muzzicato. He came to America from his native Italy in 1969. He had only four years of schooling in Italy. He immediately went to work in America and continued working until January 2007, when he injured his back while employed as a laborer for Strow’s Plumbing and Heating Company.
Strow’s insurer hired a vocational expert to determine Sam’s earning power. The expert came up with five possible jobs in the immediate labor market:
– Cashier at a Jiffy Lube
– Teller at a local casino
– Dispatcher for a trucking company
– A customer sales rep
– Front desk clerk in a hotel
Do you see a common denominator in all of these jobs? Some degree of computer literacy is needed. The Administrative Law Judge dismissed the first four jobs as not within Sam’s capabilities, but for unknown reasons determined that he could perform the desk clerk position. With this theoretical job available, the ALJ approved a reduction in Sam’s weekly indemnity benefit.
Here is the theory in PA law behind the wage reduction:

“[A]n employer may seek modification of a claimant’s benefits by either offering the claimant a specific job that it has available that he is capable of performing or establishing earning power through expert opinion evidence.”

Sam appealed to the Commonwealth Court, where the judges determined that the inclusion of the single job by the ALJ was capricious, and that Sam was incapable of performing any of the jobs recommended by the voc expert. Sam, in other words, has few, if any, transferable skills. When his body broke down, he had nothing to bring to the marketplace. As a result, his full indemnity will continue.
Broken Bodies
Sam’s story is by no means unique. Many of the immigrants who came to this country to find work had limited education in their native lands. Once here, they were too busy or too indifferent to pursue educational goals. They gained a foothold through hard work, perhaps shifting educational goals onto their children. Now as they enter the waning years of employment, their bodies break down. Where once they recovered quickly from workplace injuries, now the pain lingers, eroding their capacity to work. And once out of work, there is literally no place to go.
What lies ahead for the Sam Muzzicatos of the world? While it sounds odd to say it, Sam is lucky that he was injured at work. His back problems will be treated through the comp system for the foreseeable future. He will collect roughly 2/3 of his average weekly wage, tax free, at least until his eligibility for temporary total benefits runs out. After that, he will probably qualify for some form of permanent partial award. Sam, in other words, will transition rather smoothly into retirement through the generosity of the workers comp system.
Strow’s Plumbing and Heating will foot the bill through the experience rating process for three years. After that, the insurer will be on the hook for whatever is owed to Sam. Is this fair? Does it make sense? Is Sam being rewarded for his failure over the years to improve his skills through education? Ironically, if Sam did have transferable skills, his benefits would have been reduced, despite the fact that he might not be able to find work in this troubled economy. Would that have been fair? Indeed, in the world of workers comp, as judges parse the letter of the law and and employers struggle to pay the bills and injured workers battle to survive, is fairness even an issue under consideration?

Health literacy: employees at risk

Wednesday, February 28th, 2007

Last week, Ezra Klein put the issue of health literacy back on our radar screen with a link to a recent Washington Post article, A Silent Epidemic. The article discusses the complexity of the health care system, and how a huge swath of the population is unprepared to effectively engage that system because of functional illiteracy, language, or culture. The article cites a 1999 report by the American Medical Association finding that most medical forms are written at a graduate school level while the average U.S. adult has eighth-grade level literacy skills. Another study cited painted a bleaker picture:

A study published in the Journal of the American Medical Association in 1995 found that more than 80 percent of patients treated at two of the nation’s largest public hospitals could not understand instructions written at the fourth-grade level for the preparation of gastrointestinal X-rays known as an upper GI series. A 1999 study of more than 3,200 Medicare recipients found that one in three native-born patients could not answer a question about normal blood sugar readings even after being given a paper to read that listed the correct answer. And a study of 2,500 elderly patients published last year in the Journal of General Internal Medicine reported that patients with low health literacy were twice as likely to die during a five-year period as those with adequate skills, regardless of age, race or income.

The Joint Commission recently issued a report 65-page report on this issue entitled “What Did the Doctor Say?”: Improving Health Literacy to Protect Patient Safety (PDF), but if you’d like a quick executive summary, see recent press release on Low Health Literacy Puts Patients at Risk, which offers a summary of the issue along with some specific recommendations for healthcare providers to address the problem. These include:

  • The sensitization, education and training of clinicians and health care organization leaders and staff regarding health literacy issues and patient-centered communications.
  • The development of patient-friendly navigational aids in health care facilities.
  • The enhanced training and use of interpreters for patients.
  • The re-design of informed consent forms and the informed consent process.
  • The development of insurance enrollment forms and benefits explanations that are “client-centered.”
  • The use of established patient communication methods such as “teach back.”
  • The expanded adaptation and use of adult learning centers to meet patient health literacy needs.
  • The development of patient self-management skills.
  • Health care organization assessment of the literacy levels and language needs of the communities they serve.
  • The design of public health interventions that are audience-centered and can be communicated in the context of the lives of the target population.
  • The integration of the patient communication priority into emerging physician pay-for-performance programs.
  • The provision of medical liability insurance discounts for physicians who apply patient-centered communication techniques.

Workers compensation implications
This issue has great relevance to employers for the implications that health literacy can have on workers compensation, general disability, and general work force wellness. Good outcomes require good communication. If you want to ensure that your workers get good medical care and return to health and to work as soon as possible, effective communication between the injured worker and the treating physician is essential. And it would appear that if the average reading comprehension is at eighth grade level, few employers are immune. The challenges for employers with a high population of unskilled workers or workers who have or no English are even greater.
First and foremost, employers and managers should understand the risks inherent in their work force. Illiteracy is also an issue that with enormous implications for safety and training. Organizations with a work population that is at high risk from a health literacy perspective should also take particular care to select physicians who have cultural competence. And when a work injury occurs, there may be a need for a health care liaison to help and advocate for the injured worker. For complex cases, this might be a nurse case manager. For simple injuries, employers might assign a workers comp injury coordinator who would follow up with the injured worker frequently during the recovery process, and verify that medical instructions are understood and being followed. A translator might also be part of the care team if the worker has limited English.
Related posts:
When it comes to safety, make sure you speak the same language!
A health literacy crisis looming?
Cultural competence in healthcare and beyond

A health literacy crisis looming?

Friday, April 16th, 2004

A few weeks ago, we featured an article that discussed the need for cultural competence in healthcare – “the ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients.”

More recently, The Health Show pointed us to a recent report by the Institute of Medicine (IOM) suggesting that 90 million Americans face significant health literacy issues. The IOM emphasizes taht this is not simply an issue that faces the uneducated or the poor. According to the report:

“Health literacy skills are needed for discussing care with health professionals; reading and understanding patient information sheets, consent forms, and advertising; and using medical tools such as a thermometer. Over 300 studies indicate that health-related materials cannot be understood by most of the people for whom they are intended.

Individuals are increasingly responsible for managing their own health care, the committee noted. They are assuming new roles in seeking information, measuring and monitoring their own health, and making decisions about insurance and options for care. Patients’ health often depends on their ability and willingness to carry out a set of activities needed to manage and treat their disease. This self-management is essential to successful care of chronic diseases such as diabetes, HIV, and hypertension. Patients with chronic illness who have limited health literacy are less knowledgeable about disease management and less likely to use preventive measures.

Limited health literacy is not a problem that starts and ends with patients, the committee added. Health systems are becoming increasingly complex, involving new technologies, scientific jargon, and complicated medical procedures and forms. All of these aspects of the health system can be confusing to patients.”

In the midst of this increasing complexity, throw the $3 billion in annual drug advertising that pharmaceutical companies spend on direct-to-consumer advertising into the mix. While ads previously focused on discretionary types of treatments, pharmaceutical companies are increasingly advertising complex treatments for serious health conditions.

To remedy the health literacy issue, the IOM suggests that practical health education and skills be added to the curricula from kindergarten through high school, as well as in adult education and community programs.

From a workers comp perspective, this makes the case for nurse case managers as health care advocates and educators, particularly in complex cases. However, case managers are often introduced too late in a claim after the treatment trajectory has been set. Also, their role is too often viewed as mere “cost control” when the most effective goal would be to foster recovery and return to work.